Change of Heart
The incidence of heart attack in women increases significantly after they reach menopause. Estrogen helps keep arteries pliable, and its decline may explain why blood pressure and LDL, or bad cholesterol, tend to rise during this time, says Deborah Kwon, MD, a cardiologist at the Cleveland Clinic. In addition, late peri- and postmenopause are associated with greater fat deposits around the heart, which has been linked to an increased risk (up to 54 percent) of heart disease, according to a 2015 study.

Healthy habit: Blast away ab flab. The fat that forms in your middle is especially toxic: "It produces compounds such as inflammatory proteins called cytokines, which have been linked to insulin resistance and type 2 diabetes as well as heart disease," explains Scott Isaacs, MD, an endocrinologist and adjunct instructor at Emory University School of Medicine. One possible solution is to start hormone therapy, but timing may be key. "If you go on HT while you're experiencing perimenopause, it can help protect you from developing this bigger belly. But if you wait until you've passed menopause, it may be too late," says Deborah Clegg, PhD, a professor of biomedical sciences at Cedars-Sinai in Los Angeles. If you can't take HT or prefer not to, focus on committing to regular exercise and eating a diet low in sugar and saturated fat and rich in fruits, vegetables, whole grains, nuts, fish, and lean protein.

Oops, I Did It Again
Urinary incontinence peaks around menopause, with studies suggesting that between 30 and 40 percent of women in middle age experience some form of urine leakage. "As estrogen levels decline, vaginal and urinary tract muscles may weaken, making it more likely you'll have episodes of incontinence," explains Diana Bitner, MD, an ob-gyn who specializes in menopause at Spectrum Health in Grand Rapids, Michigan. If you've put on weight, your odds of incontinence grow, thanks to increased pressure on your bladder and surrounding muscles.

Try this: Vaginal estrogen. You apply it—as either a prescription cream, suppository, or vaginal ring—to your genital area to replace declining estrogen in those tissues. "It will definitely ease urinary incontinence as well as symptoms like vaginal dryness, itching, and irritation," says Bitner. Bonus: This boost of estrogen helps balance levels of vaginal bacteria, which in turn keeps vaginal pH (acidity) in line, reducing your risk of developing both yeast and urinary tract infections.

That's A Fact!
Pelvic floor exercise can help plug leaks: Participants in a Canadian clinical trial reduced their incidence of urinary incontinence by 75 percent after just 12 weekly sessions of physical therapy.

Not-So-Tenacious D
Called the sunshine vitamin because your skin synthesizes it after exposure to sunlight, vitamin D acts as a hormone to help maintain strong bones and modulate your immune system as well as your muscle and nerve function. Research suggests that vitamin D may also play a role in protecting cognition: In a University of Exeter study, adults 65 or older who were moderately deficient in vitamin D had a 53 percent higher risk of developing dementia; for the severely deficient, the risk rose to 125 percent. The potential to become deficient increases with age. "As you get older, your skin becomes less efficient in using the sun's rays to make vitamin D, so your body requires more," explains Michal Melamed, MD, associate professor of medicine at Albert Einstein College of Medicine.

Try this: Consider a daily vitamin D supplement since you may not be able to get enough from food and UV exposure alone. While the Institute of Medicine recommends women in their 50s and 60s get 600 IUs daily, that's most likely not sufficient for everyone, says Melamed. In a small pilot study presented at the Society for Endocrinology's annual meeting last November, people who took 2,000 IUs daily for two weeks had lower blood pressure, lower levels of the stress hormone cortisol, and better fitness performance than placebo takers. But don't exceed that amount. "Some research has linked high dosages to an increased risk of developing kidney stones," stresses Melamed.

Researchers at Iowa State University are studying an easy way to boost vitamin D levels: eating eggs, including the yolk, which is rich in a form of the vitamin. Sunny-side up, please!

Learn how manage changing hormones in your 30s and 40s too.


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